AAFP Guidelines Bundle

Atrial Fibrillation - Pharmacological Management

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Treatment ➤ ➤ Rate control is preferred over rhythm control for the majority of patients who have atrial fibrillation (S-M). Preferred options for rate-control therapy include non-dihydropyridine calcium channel blockers and beta blockers. Rhythm control may be considered for certain patients based on patient symptoms, exercise tolerance, and patient preferences (W-L). ➤ ➤ Lenient rate control (<110 beats per minute resting) is preferred over strict rate control (<80 beats per minute resting) for patients who have atrial fibrillation (W-L). ➤ ➤ Clinicians should discuss the risk of stroke and bleeding with all patients considering anticoagulation (GP). Clinicians should consider using the continuous CHADS 2 or continuous CHA 2 DS 2 -VASc for prediction of risk of stroke (W-L) and HAS-BLED for prediction of risk for bleeding (W-L) in patients who have atrial fibrillation. ➤ ➤ Patients who have atrial fibrillation should receive chronic anticoagulation unless they are at low risk of stroke (CHADS 2 <2) or have specific contraindications (S-H). • Choice of anticoagulation therapy should be based on patient preferences and patient history. Options for anticoagulation therapy may include warfarin, apixaban, dabigatran, edoxaban, or rivaroxaban. ➤ ➤ Dual treatment with anticoagulant and antiplatelet therapy is NOT recommended for most patients who have atrial fibrillation (S-M). Table 1. CHADS 2 Risk Assessment Score Risk Factor Score (if present) C Congestive heart failure 1 H Hypertension 1 A Age ≥75 y 1 D Diabetes mellitus 1 S Prior stroke or TIA 2 Total Score for a maximum of 6

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